“Housing First” offers glimmer of hope for homeless veterans, others

On this Veterans' Day, when we remember those who have served, it is troubling to note that, although veterans make up around 9 percent of our population, they comprise 23 percent of our homeless population and fully a third of our homeless men. In a country that perpetually holds itself up as the best, most compassionate in the world, it is a disgrace that we do so little for this troubled part of our society.

76 percent of our homeless veterans experience mental illness or alcohol/drug abuse problems, according to the National Coalition for Homeless Veterans. Homeless veterans tend to be whiter and older than homeless non-veterans, with 46 percent of them white males (compared to 34 percent of white males among non-veteran homeless), and 46 percent also older than age 45 (the number is 20 percent among non-veterans). Nearly half served during the Vietnam War years.

The reasons are complex, says the coalition's website:

"In addition to the complex problems associated with homelessness - extreme shortage of affordable housing, livable income, and access to health care - a large number of displaced and at-risk veterans live with lingering effects of Post Traumatic Stress Disorder (PTSD) and substance abuse, compounded by a lack of family and social support networks. Military occupations and training are not always transferable to the civilian workforce, placing some veterans at a disadvantage when competing for employment . . . While most homeless people are single, unaffiliated men... most housing money in existing federal homelessness programs is devoted to helping homeless families or homeless women with dependant children."

Seattle is among the nation's foremost innovators in seeking better ways to address the problems of its homeless population. It sounds so simple, but providing housing has in itself been found to bring major results in decreasing medical and social problems for the homeless while also decreasing public costs. What makes this most basic of all gestures innovative is that in Seattle it is being provided without preconditions, unlike other programs that, in effect, require homeless to first become clean, well and sober as a prerequisite to receiving housing. Seattle's Downtown Emergency Services Corporation (DESC) believes that providing housing unconditionally can reduce those problems more effectively and humanely than can providing it only, in effect, as a reward for shaping up.

The evidence is beginning to support them. In a study published earlier this year in the Journal of the American Medical Association, researchers at the University of Washington found that Housing First was saving public expenses and reducing drinking among homeless alcoholics. From a summary:

"Providing housing and support services for homeless alcoholics costs taxpayers less than leaving them on the street, where taxpayer money goes towards police and emergency health care. Stable housing also results in reduced drinking among homeless alcoholics, according to a Seattle-based study published today in the Journal of the American Medical Association (JAMA).

"The study found that the program saved taxpayers more than $4 million dollars over the first year of operation. During the first six months, even after considering the cost of administering housing for the 95 residents in a Housing First program in downtown Seattle, the study reported an average cost-savings of 53 percent -- nearly $2,500 per month per person in health and social services, compared to the costs of a wait-list control group of 39 homeless people."

"Our study suggests that homeless alcoholics who qualify to take part in Housing First can stay out of jails and emergency rooms, and cost the taxpayer a lot less money as a result," said Mary E. Larimer, PhD, professor of psychiatry and behavioral sciences and adjunct professor of psychology at the University of Washington and lead author of the study, in a press statement.

The 1811 Eastlake study, funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation, was the first US controlled assessment of the effectiveness of Housing First specifically targeting chronically homeless alcoholics. The authors concluded that several factors were key to the success of the program, including the decisions to limit rules and regulations on residents, and to provide them with supportive case managers, as well as easy access to providers of mental health and health care services within the housing program. The 1811 Eastlake facility is pictured above. Another DESC facility, the Kerner-Scott House, is pictured to the left.

Citiwire's Neal Peirce observes that on a typical night 650,000 Americans have no place to call home, and that as a society we created the problem ourselves, by the states emptying out their mental hospitals and cities demolishing thousands of low-income rental units. Unrestrained health care costs haven't helped, either. Peirce writes that "alarming numbers are being forced to take to the streets where their health is even more endangered by extremes of pelting rain or stone-cold nights, unsanitary conditions, sometimes violence."

On the brighter side, Peirce sees hope that fewer cities are taking a "law and order" approach to homelessness, the Seattle program is emerging as a model, and the Obama administration seems sincere in wanting to address the issue. Leaders in Phoenix seem to be taking note, and Laura Vanderkam writes in USA Today that a Housing First program in Portland led to a 70 percent drop in the city's chronic homeless population when augmented by sufficient outreach staff and the creation of enough permanent housing units supported by counselors and nurses to offer one to just about anyone willing to give it a try.

Our nation's homeless, and especially our veterans, deserve no less. If you know a veteran, thank him or her for their service. If your community has a homeless program, support it.

Kaid Benfield writes (almost) daily about community, development, and the environment. For more posts, see his blog's home page.

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